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Published in: Archives of Gynecology and Obstetrics 2/2011

01-02-2011 | Materno-fetal Medicine

Effect of milk and calcium supplementation on bone density and bone turnover in pregnant Chinese women: a randomized controlled trail

Authors: Zhen Liu, Ling Qiu, Yu-ming Chen, Yi-xiang Su

Published in: Archives of Gynecology and Obstetrics | Issue 2/2011

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Abstract

Objective

Calcium demand is increased during pregnancy. However, few randomized controlled trials examined the effects of calcium supplementation on bone mass during pregnancy. This study determined effects of calcium and milk supplementation on maternal bone mineral density (BMD) and bone turnover in pregnant Chinese women with habitual low calcium intake.

Methods

In this randomized controlled trial, 36 Chinese pregnant women (24–31 years, 18 gestational weeks) were randomly assigned to the following three arms (12 each): I, usual diet; II, “I” + 45 g milk powder (containing 350 mg calcium); or III, “II” + 600 mg calcium/day from gestational age of 20 weeks to 6 weeks post-partum (PP). BMD was measured post-treatment using dual-energy X-ray absorptiometry. Dietary intakes, 24-h urinary calcium, bone resorption (urinary hydroxyproline) and formation (serum osteocalcin) biomarkers were examined at the gestational age of 20 and 34 weeks, and 6 weeks PP.

Results

A dose-dependent relationship was observed between calcium intake and BMDs. The BMD values were significantly higher in subjects with calcium and milk supplementation than those in the controls at the whole body and spine (p < 0.05) but not at the hip sites. We found significant decreases in changes of urinary hydroxyproline, and significant increases in serum osteocalcin during the intervention period in the calcium/milk intervention groups than those in the control group (all p < 0.05).

Conclusion

Calcium/milk supplementation during pregnancy is associated with greater BMD at the spine and whole body and suppresses bone resorption in Chinese women with habitual low calcium intake.
Literature
1.
go back to reference Prentice A (2003) Micronutrients and the bone mineral content of the mother, fetus and newborn. J Nutr 133:1693S–1699SPubMed Prentice A (2003) Micronutrients and the bone mineral content of the mother, fetus and newborn. J Nutr 133:1693S–1699SPubMed
2.
go back to reference Forbes GB (1976) Letter: calcium accumulation by the human fetus. Pediatrics 57:976–977PubMed Forbes GB (1976) Letter: calcium accumulation by the human fetus. Pediatrics 57:976–977PubMed
3.
go back to reference Heaney RP, Skillman TG (1971) Calcium metabolism in normal human pregnancy. J Clin Endocrinol Metab 33:661–670CrossRefPubMed Heaney RP, Skillman TG (1971) Calcium metabolism in normal human pregnancy. J Clin Endocrinol Metab 33:661–670CrossRefPubMed
4.
go back to reference O’Brien KO, Donangelo CM, Zapata CL, Abrams SA, Spencer EM, King JC (2006) Bone calcium turnover during pregnancy and lactation in women with low calcium diets is associated with calcium intake and circulating insulin-like growth factor 1 concentrations. Am J Clin Nutr 83:317–323PubMed O’Brien KO, Donangelo CM, Zapata CL, Abrams SA, Spencer EM, King JC (2006) Bone calcium turnover during pregnancy and lactation in women with low calcium diets is associated with calcium intake and circulating insulin-like growth factor 1 concentrations. Am J Clin Nutr 83:317–323PubMed
5.
go back to reference Kovacs CS (2001) Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab 86:2344–2348CrossRefPubMed Kovacs CS (2001) Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab 86:2344–2348CrossRefPubMed
6.
go back to reference Sowers M (1996) Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 11:1052–1060CrossRefPubMed Sowers M (1996) Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 11:1052–1060CrossRefPubMed
7.
go back to reference Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370:657–666CrossRefPubMed Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370:657–666CrossRefPubMed
8.
go back to reference Winzenberg T, Shaw K, Fryer J, Jones G (2006) Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomised controlled trials. BMJ 333:775–781CrossRefPubMed Winzenberg T, Shaw K, Fryer J, Jones G (2006) Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomised controlled trials. BMJ 333:775–781CrossRefPubMed
9.
go back to reference Welten DC, Kemper HC, Post GB, Van Staveren WA (1995) A meta-analysis of the effect of calcium intake on bone mass in young and middle aged females and males. J Nutr 125:2802–2813PubMed Welten DC, Kemper HC, Post GB, Van Staveren WA (1995) A meta-analysis of the effect of calcium intake on bone mass in young and middle aged females and males. J Nutr 125:2802–2813PubMed
10.
go back to reference Zeni SN, Ortela Soler CR, Lazzari A, Lopez L, Suarez M, Di Gregorio S, Somoza JI, de Portela ML (2003) Interrelationship between bone turnover markers and dietary calcium intake in pregnant women: a longitudinal study. Bone 33:606–613CrossRefPubMed Zeni SN, Ortela Soler CR, Lazzari A, Lopez L, Suarez M, Di Gregorio S, Somoza JI, de Portela ML (2003) Interrelationship between bone turnover markers and dietary calcium intake in pregnant women: a longitudinal study. Bone 33:606–613CrossRefPubMed
11.
go back to reference Olausson H, Laskey MA, Goldberg GR, Prentice A (2008) Changes in bone mineral status and bone size during pregnancy and the influences of body weight and calcium intake. Am J Clin Nutr 88:1032–1039PubMed Olausson H, Laskey MA, Goldberg GR, Prentice A (2008) Changes in bone mineral status and bone size during pregnancy and the influences of body weight and calcium intake. Am J Clin Nutr 88:1032–1039PubMed
12.
go back to reference Janakiraman V, Ettinger A, Mercado-Garcia A, Hu H, Hernandez-Avila M (2003) Calcium supplements and bone resorption in pregnancy: a randomized crossover trial. Am J Prev Med 24:260–264CrossRefPubMed Janakiraman V, Ettinger A, Mercado-Garcia A, Hu H, Hernandez-Avila M (2003) Calcium supplements and bone resorption in pregnancy: a randomized crossover trial. Am J Prev Med 24:260–264CrossRefPubMed
13.
go back to reference Avendano-Badillo D, Hernandez-Avila M, Hernandez-Cadena L, Rueda-Hernandez G, Solano-Gonzalez M, Ibarra LG, Hu H, Tellez-Rojo MM (2009) High dietary calcium intake decreases bone mobilization during pregnancy in humans. Salud Publica Mex 51(Suppl 1):S100–S107PubMed Avendano-Badillo D, Hernandez-Avila M, Hernandez-Cadena L, Rueda-Hernandez G, Solano-Gonzalez M, Ibarra LG, Hu H, Tellez-Rojo MM (2009) High dietary calcium intake decreases bone mobilization during pregnancy in humans. Salud Publica Mex 51(Suppl 1):S100–S107PubMed
14.
go back to reference Kolthoff N, Eiken P, Kristensen B, Nielsen SP (1998) Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin Sci 94:405–412PubMed Kolthoff N, Eiken P, Kristensen B, Nielsen SP (1998) Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin Sci 94:405–412PubMed
15.
go back to reference Krishnamachari KA, Iyengar L (1975) Effect of maternal malnutrition on the bone density of the neonates. Am J Clin Nutr 28:482–486PubMed Krishnamachari KA, Iyengar L (1975) Effect of maternal malnutrition on the bone density of the neonates. Am J Clin Nutr 28:482–486PubMed
16.
go back to reference Kent GN, Price RI, Gutteridge DH, Rosman KJ, Smith M, Allen JR, Hickling CJ, Blakeman SL (1991) The efficiency of intestinal calcium absorption is increased in late pregnancy but not in established lactation. Calcif Tissue Int 48:293–295CrossRefPubMed Kent GN, Price RI, Gutteridge DH, Rosman KJ, Smith M, Allen JR, Hickling CJ, Blakeman SL (1991) The efficiency of intestinal calcium absorption is increased in late pregnancy but not in established lactation. Calcif Tissue Int 48:293–295CrossRefPubMed
17.
go back to reference Holmberg-Marttila D, Sievanen H, Tuimala R (1999) Changes in bone mineral density during pregnancy and postpartum: prospective data on five women. Osteoporos Int 10:41–46CrossRefPubMed Holmberg-Marttila D, Sievanen H, Tuimala R (1999) Changes in bone mineral density during pregnancy and postpartum: prospective data on five women. Osteoporos Int 10:41–46CrossRefPubMed
18.
go back to reference More C, Bettembuk P, Bhattoa HP, Balogh A (2001) The effects of pregnancy and lactation on bone mineral density. Osteoporos Int 12:732–737CrossRefPubMed More C, Bettembuk P, Bhattoa HP, Balogh A (2001) The effects of pregnancy and lactation on bone mineral density. Osteoporos Int 12:732–737CrossRefPubMed
19.
go back to reference Pearson D, Kaur M, San P, Lawson N, Baker P, Hosking D (2004) Recovery of pregnancy mediated bone loss during lactation. Bone 34:570–578CrossRefPubMed Pearson D, Kaur M, San P, Lawson N, Baker P, Hosking D (2004) Recovery of pregnancy mediated bone loss during lactation. Bone 34:570–578CrossRefPubMed
20.
go back to reference Kaur M, Pearson D, Godber I, Lawson N, Baker P, Hosking D (2003) Longitudinal changes in bone mineral density during normal pregnancy. Bone 32:449–454CrossRefPubMed Kaur M, Pearson D, Godber I, Lawson N, Baker P, Hosking D (2003) Longitudinal changes in bone mineral density during normal pregnancy. Bone 32:449–454CrossRefPubMed
21.
go back to reference Naylor KE, Iqbal P, Fledelius C, Fraser RB, Eastell R (2000) The effect of pregnancy on bone density and bone turnover. J Bone Miner Res 15:129–137CrossRefPubMed Naylor KE, Iqbal P, Fledelius C, Fraser RB, Eastell R (2000) The effect of pregnancy on bone density and bone turnover. J Bone Miner Res 15:129–137CrossRefPubMed
22.
go back to reference Ulrich U, Miller PB, Eyre DR, Chesnut CH 3rd, Schlebusch H, Soules MR (2003) Bone remodeling and bone mineral density during pregnancy. Arch Gynecol Obstet 268:309–316CrossRefPubMed Ulrich U, Miller PB, Eyre DR, Chesnut CH 3rd, Schlebusch H, Soules MR (2003) Bone remodeling and bone mineral density during pregnancy. Arch Gynecol Obstet 268:309–316CrossRefPubMed
23.
go back to reference Drinkwater BL, Chesnut CH 3rd (1991) Bone density changes during pregnancy and lactation in active women: a longitudinal study. J Bone Miner Metab 14:153–160 Drinkwater BL, Chesnut CH 3rd (1991) Bone density changes during pregnancy and lactation in active women: a longitudinal study. J Bone Miner Metab 14:153–160
24.
go back to reference Yamaga A, Taga M, Minaguchi H, Sato K (1996) Changes in bone mass as determined by ultrasound and biochemical markers of bone turnover during pregnancy and puerperium: a longitudinal study. J Clin Endocrinol Metab 81:752–756CrossRefPubMed Yamaga A, Taga M, Minaguchi H, Sato K (1996) Changes in bone mass as determined by ultrasound and biochemical markers of bone turnover during pregnancy and puerperium: a longitudinal study. J Clin Endocrinol Metab 81:752–756CrossRefPubMed
25.
go back to reference Walker GL, Danielson DM, Peo ER Jr, Mumm RF (1993) Effect of calcium source, dietary calcium concentration, and gestation phase on various bone characteristics in gestating gilts. J Anim Sci 71:3003–3010PubMed Walker GL, Danielson DM, Peo ER Jr, Mumm RF (1993) Effect of calcium source, dietary calcium concentration, and gestation phase on various bone characteristics in gestating gilts. J Anim Sci 71:3003–3010PubMed
26.
go back to reference Glade MJ (1993) Effects of gestation, lactation, and maternal calcium intake on mechanical strength of equine bone. J Am Coll Nutr 12:372–377PubMed Glade MJ (1993) Effects of gestation, lactation, and maternal calcium intake on mechanical strength of equine bone. J Am Coll Nutr 12:372–377PubMed
27.
go back to reference Chan GM, McElligott K, McNaught T, Gill G (2006) Effects of dietary calcium intervention on adolescent mothers and newborns: a randomized controlled trial. Obstet Gynecol 108:565–571CrossRefPubMed Chan GM, McElligott K, McNaught T, Gill G (2006) Effects of dietary calcium intervention on adolescent mothers and newborns: a randomized controlled trial. Obstet Gynecol 108:565–571CrossRefPubMed
28.
go back to reference Ganpule A, Yajnik CS, Fall CH, Rao S, Fisher DJ, Kanade A, Cooper C, Naik S, Joshi N, Lubree H, Deshpande V, Joglekar C (2006) Bone mass in Indian children—relationships to maternal nutritional status and diet during pregnancy: the Pune Maternal Nutrition Study. J Clin Endocrinol Metab 91:2994–3001CrossRefPubMed Ganpule A, Yajnik CS, Fall CH, Rao S, Fisher DJ, Kanade A, Cooper C, Naik S, Joshi N, Lubree H, Deshpande V, Joglekar C (2006) Bone mass in Indian children—relationships to maternal nutritional status and diet during pregnancy: the Pune Maternal Nutrition Study. J Clin Endocrinol Metab 91:2994–3001CrossRefPubMed
29.
go back to reference Koo WW, Walters JC, Esterlitz J, Levine RJ, Bush AJ, Sibai B (1999) Maternal calcium supplementation and fetal bone mineralization. Obstet Gynecol 94:577–582CrossRefPubMed Koo WW, Walters JC, Esterlitz J, Levine RJ, Bush AJ, Sibai B (1999) Maternal calcium supplementation and fetal bone mineralization. Obstet Gynecol 94:577–582CrossRefPubMed
30.
go back to reference O’Brien KO, Nathanson MS, Mancini J, Witter FR (2003) Calcium absorption is significantly higher in adolescents during pregnancy than in the early postpartum period. Am J Clin Nutr 78:1188–1193PubMed O’Brien KO, Nathanson MS, Mancini J, Witter FR (2003) Calcium absorption is significantly higher in adolescents during pregnancy than in the early postpartum period. Am J Clin Nutr 78:1188–1193PubMed
31.
go back to reference Duan Y, Beck TJ, Wang XF, Seeman E (2003) Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging. J Bone Miner Res 18:1766–1774CrossRefPubMed Duan Y, Beck TJ, Wang XF, Seeman E (2003) Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging. J Bone Miner Res 18:1766–1774CrossRefPubMed
32.
go back to reference Black AJ, Topping J, Durham B, Farquharson RG, Fraser WD (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15:557–563CrossRefPubMed Black AJ, Topping J, Durham B, Farquharson RG, Fraser WD (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15:557–563CrossRefPubMed
33.
go back to reference Sowers M, Crutchfield M, Jannausch M, Updike S, Corton G (1991) A prospective evaluation of bone mineral change in pregnancy. Obstet Gynecol 77:841–845PubMed Sowers M, Crutchfield M, Jannausch M, Updike S, Corton G (1991) A prospective evaluation of bone mineral change in pregnancy. Obstet Gynecol 77:841–845PubMed
34.
go back to reference Lotz JC, Cheal EJ, Hayes WC (1995) Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fracture. Osteoporos Int 5:252–261CrossRefPubMed Lotz JC, Cheal EJ, Hayes WC (1995) Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fracture. Osteoporos Int 5:252–261CrossRefPubMed
35.
go back to reference Oden ZM, Selvitelli DM, Bouxsein ML (1999) Effect of local density changes on the failure load of the proximal femur. J Orthop Res 17:661–667CrossRefPubMed Oden ZM, Selvitelli DM, Bouxsein ML (1999) Effect of local density changes on the failure load of the proximal femur. J Orthop Res 17:661–667CrossRefPubMed
36.
go back to reference Yoon BK, Lee JW, Choi DS, Roh CR, Lee JH (2000) Changes in biochemical bone markers during pregnancy and puerperium. J Kor Med Sci 15:189–193 Yoon BK, Lee JW, Choi DS, Roh CR, Lee JH (2000) Changes in biochemical bone markers during pregnancy and puerperium. J Kor Med Sci 15:189–193
37.
go back to reference Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J (2000) The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int 11(Suppl 6):S2–S17CrossRefPubMed Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J (2000) The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int 11(Suppl 6):S2–S17CrossRefPubMed
38.
go back to reference Christenson RH (1997) Biochemical markers of bone metabolism: an overview. Clin Biochem 30:573–593CrossRefPubMed Christenson RH (1997) Biochemical markers of bone metabolism: an overview. Clin Biochem 30:573–593CrossRefPubMed
39.
go back to reference Kusumi T, Kusumi A (2004) Osteocalcin/bone Gla protein(BGP). Nippon Rinsho 62(Suppl 2):136–140PubMed Kusumi T, Kusumi A (2004) Osteocalcin/bone Gla protein(BGP). Nippon Rinsho 62(Suppl 2):136–140PubMed
40.
41.
go back to reference Calvo MS, Eyre DR, Gundberg CM (1996) Molecular basis and clinical application of biological markers of bone turnover. Endocr Rev 17:333–368PubMed Calvo MS, Eyre DR, Gundberg CM (1996) Molecular basis and clinical application of biological markers of bone turnover. Endocr Rev 17:333–368PubMed
42.
go back to reference Weaver CM, Peacock M, Martin BR, Plawecki KL, McCabe GP (1996) Calcium retention estimated from indicators of skeletal status in adolescent girls and young women. Am J Clin Nutr 64:67–70PubMed Weaver CM, Peacock M, Martin BR, Plawecki KL, McCabe GP (1996) Calcium retention estimated from indicators of skeletal status in adolescent girls and young women. Am J Clin Nutr 64:67–70PubMed
43.
go back to reference Paton LM, Alexander JL, Nowson CA, Margerison C, Frame MG, Kaymakci B, Wark JD (2003) Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study. Am J Clin Nutr 77:707–714PubMed Paton LM, Alexander JL, Nowson CA, Margerison C, Frame MG, Kaymakci B, Wark JD (2003) Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study. Am J Clin Nutr 77:707–714PubMed
44.
go back to reference Petersen HC, Jeune B, Vaupel JW, Christensen K (2002) Reproduction life history and hip fractures. Ann Epidemiol 12:257–263CrossRefPubMed Petersen HC, Jeune B, Vaupel JW, Christensen K (2002) Reproduction life history and hip fractures. Ann Epidemiol 12:257–263CrossRefPubMed
45.
go back to reference Paganini-Hill A, Atchison KA, Gornbein JA, Nattiv A, Service SK, White SC (2005) Menstrual and reproductive factors and fracture risk: the Leisure World Cohort Study. J Women’s Health 14:808–819CrossRef Paganini-Hill A, Atchison KA, Gornbein JA, Nattiv A, Service SK, White SC (2005) Menstrual and reproductive factors and fracture risk: the Leisure World Cohort Study. J Women’s Health 14:808–819CrossRef
Metadata
Title
Effect of milk and calcium supplementation on bone density and bone turnover in pregnant Chinese women: a randomized controlled trail
Authors
Zhen Liu
Ling Qiu
Yu-ming Chen
Yi-xiang Su
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Archives of Gynecology and Obstetrics / Issue 2/2011
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-009-1345-0

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